Faren H. Williams, MD, MS
Physiatrist, Professor
UMass Chan Medical School
Worcester, Massachusetts, United States
Evan Sirls, BS
Medical Student
UMass Chan Medical School
Bloomfield Hills, Michigan, United States
A 48-year-old female (Patient A) and a 55-year-old-male (Patient B) were diagnosed with Parsonage-Turner Syndrome. The patient with earlier treatment had more significant recovery.
Case Description:
Patient A presented to Physiatry clinic with 1.5 weeks of left sided neck and shoulder pain radiating to the hand. She also had left hand paresthesias and weakness which had worsened. As an OB/GYN physician, this limited her ability to perform pelvic exams and do surgery. Patient B presented to the same clinic with 2 months of significant left shoulder and periscapular pain after playing golf. He had proximal left arm weakness affecting ADLs such as personal grooming and fastening a seatbelt. Both patients denied previous trauma or infection. After unremarkable imaging and positive electrodiagnostic findings, Patients A and B were diagnosed with brachial neuritis. They were treated with Prednisone 60 mg daily for one week, and a tapering dose for a second week. After the steroid course, Patient A had decreased pain and improved left-hand strength. Patient B had resolved pain but continued to have significant proximal arm weakness.
Discussions:
Traditional treatment for brachial neuritis includes pain management and physical therapy. Studies have suggested an association between early administration of high dose prednisone with improvement in symptoms, but this remains inconclusive. This case report, however, supports the use of prednisone during the early stages of brachial neuritis to prevent further pain and disability. Patient A could not work as an OB/GYN for a short time, but was able to return after prompt treatment. Patient B had resolution of pain, but continued to experience proximal shoulder weakness which may be related to delayed diagnosis and treatment.
Conclusions:
This case report affirms the value of Physiatrists’ clinical and electrodiagnostic skills to identify brachial neuritis in the acute phase and the potential utility of early high dose steroid administration.
